|Publication number||US8425229 B2|
|Application number||US 12/600,633|
|Publication date||23 Apr 2013|
|Filing date||21 May 2008|
|Priority date||25 May 2007|
|Also published as||CN102084365A, CN102084365B, EP2156350A1, US20100151417, WO2008145293A2|
|Publication number||12600633, 600633, PCT/2008/4072, PCT/EP/2008/004072, PCT/EP/2008/04072, PCT/EP/8/004072, PCT/EP/8/04072, PCT/EP2008/004072, PCT/EP2008/04072, PCT/EP2008004072, PCT/EP200804072, PCT/EP8/004072, PCT/EP8/04072, PCT/EP8004072, PCT/EP804072, US 8425229 B2, US 8425229B2, US-B2-8425229, US8425229 B2, US8425229B2|
|Inventors||Urban Nilsson, Matts Andersson|
|Original Assignee||Nobel Biocare Services Ag|
|Export Citation||BiBTeX, EndNote, RefMan|
|Patent Citations (66), Non-Patent Citations (1), Referenced by (10), Classifications (9), Legal Events (2)|
|External Links: USPTO, USPTO Assignment, Espacenet|
This application is a national stage application under 35 U.S.C. §371 of PCT Application No. PCT/EP2008/004072, filed on May 21, 2008, which published in English as WO 2008/145293 A2 on Dec. 4, 8008 and which claims priority benefit of Swedish Patent Application No. 0701296-6, filed on May 25, 2007, the entire contents of which applications and publication are herein incorporated by reference in their entirety.
This application pertains in general to the field of dentistry. More particularly the invention relates to a method and system for planning of dental restorative procedures and for producing dental restorations and/or dental components related to the dental restorative procedures.
Dental implant and dental restoration planning has been based on expertise and experience of a skilled dentist and was hitherto a manual task. Although it is known to perform the planning in a software based computer environment, visualizing virtual cranial and dental models, the planning has been made manually by the dentist. Based on this manual planning, dental restorations and related products thereto, such as drill guides were produced. Such a system is for instance disclosed in the international publications WO02/053056 and WO2005/055856 of the same applicant as the present application. However, these systems are dependent on the human factor and an imperfect planning may not be detected by the software based planning system.
Hence, an improved system for planning dental restorative procedure of a patient and/or of planning at least one dental component for said dental restorative procedure, capable of reducing the effect of the human factor, would be advantageous.
Accordingly, embodiments of the present invention preferably seek to mitigate, alleviate or eliminate one or more deficiencies, disadvantages or issues in the art, such as the above-identified, singly or in any combination by providing a method, a system, a computer program product, a computer-readable medium, a medical workstation, and a graphical interface useful for planning a dental restorative procedure of a patient and/for planning at least one dental restoration and/or product related to the dental restorative procedure.
Certain different aspects of the invention are recited in the attached patent claims.
According to one aspect of the invention, a method is provided, wherein the method is useful for computer-based planning of a dental restorative procedure of a patient having a craniooral space, and/or of at least one dental component for the dental restorative procedure. The method comprises determining a first spatial position of a first boundary surface, in the craniooral space, of a first dental unit of a dental restoration; determining a second spatial position of a second boundary surface, in the craniooral space remote the first boundary surface, of a second dental unit of the dental restoration; and determining a third spatial position, of at least a portion of the at least one dental component, relative at least one of the first and second spatial positions. According to a second aspect of the invention, a system that is useful for computer-based planning of a dental restorative procedure of a patient having a craniooral space, and/or of at least one dental component for the dental restorative procedure, is provided. The system comprises a first unit for determining a first spatial position of a first boundary surface, in the craniooral space, of a first dental unit of a dental restoration; a second unit for determining a second spatial position of a second boundary surface, in the craniooral space remote the first boundary surface, of a second dental unit of the dental restoration; and a third unit for determining a third spatial position, of at least a portion of the dental component, relative at least one of the first and second spatial positions. According to a third aspect of the invention, a computer program for processing by a computer is provided. The computer program computer program is useful for computer-based planning of a dental restorative procedure of a patient having a craniooral space, and/or of at least one dental component for the dental restorative procedure. The computer program comprises a first code segment for determining a first spatial position of a first boundary-surface, in the craniooral space, of a first dental unit of a dental restoration; a second code segment for determining a second spatial position of a second boundary surface, in the craniooral space remote the first boundary surface, of a second dental unit of the dental restoration; and a third code segment for determining a third spatial position, of at least a portion of the dental component, relative at least one of the first and second spatial positions. The computer program may be embodied on a computer-readable medium.
According to yet a further aspect of the invention, a graphical user interface for dental planning is provided. The graphical user interface comprises components for visualizing the method according to said first aspect of the invention.
According to yet a further aspect of the invention, a medical workstation for carrying out the method of the above mentioned aspect of the invention by running the computer program of the above mentioned further aspect of the invention is provided. The medical workstation may implement the graphical user interface of the above mentioned further aspect of the invention.
Certain further embodiments of the invention are defined in the dependent claims, wherein features for the second and subsequent aspects of the invention are as for the first aspect mutatis mutandis.
Some embodiments of the invention provide automatically adapting a shape of a bridge framework, the shape of a dental veneering, and thus even a bridge structure, e.g., a bridge framework with veneering, as well as a position of a dental implant.
Some embodiments provide for presurgical planning of a dental restorative procedure and production of dental restorations and/or products related to said dental restorative procedure without the need of preparing a plaster model of the patient oral cavity, or CT scanning a prosthesis for providing patient data for planning a dental restorative procedure. Some embodiments of the invention provide for virtual planning of a dental restoration without the need for any-kind of physical patient model.
Some embodiments of the invention provide for a faster and/or more reliable planning of a dental restorative procedure and products used therefor, as manual planning and production work is avoided entirely or to a large extent.
Some embodiments of the invention provide for a reduced possibility of errors during planning of a dental restorative procedure and products used therefor, as an entirely computer based planning is provided.
Some embodiments of the invention provide for entirely virtually computer based suggestion of a dental restorative procedure of a patient having a craniooral space, and/or of at least one dental component for said dental restorative procedure.
Some embodiments of the invention provide for entirely automatically suggestion of a dental restorative procedure of a patient having a craniooral space, and/or of at least one dental component for said dental restorative procedure, wherein said suggestion is based on patient data of the craniooral space.
Some embodiments of the invention provide for a reduced number of transfer steps during production of products used for dental restorative procedures, as only raw patient data has to be input and the rest of the planning method may be performed entirely virtually.
Some embodiments of the invention provide for a flexible planning of a dental restorative procedure and products used therefor, as user input for virtual manipulations or a user accept of automatic placement of virtual dental restorations advance of final placement may be provided.
Some embodiments of the invention provide for an early diagnosis of the dental situation of the patient during planning of a dental restorative procedure and products used therefor.
Some embodiments of the invention provide for a guided dental surgery with reduced inconvenience and pain for the patient, as an optimal fit of a dental restoration is provided. For instance, by virtually planning a final dental restoration without the need of re-scanning the patient with a prosthesis, the number of treatment occasions and total treatment time may be reduced. Furthermore, both final dental restorations and related products, such as drill guides may be provided from the same input data in a single automated procedure.
It should be emphasized that the term “comprises/comprising” when used in this specification is taken to specify the presence of stated features, integers, steps or components but does not preclude the presence or addition of one or more other features, integers, steps, components or groups thereof.
These and other aspects, features and advantages of which embodiments of the invention are capable of will be apparent and elucidated from the following description of embodiments of the present invention, reference being made to the accompanying drawings, in which
Specific embodiments of the invention now will be described with reference to the accompanying drawings. This invention may, however, be embodied in many different forms and should not be construed as limited to the embodiments set forth herein; rather, these embodiments are provided so that this disclosure will be thorough and complete, and will fully convey the scope of the invention to those skilled in the art. The terminology used in the detailed description of the embodiments illustrated in the accompanying drawings is not intended to be limiting of the invention. In the drawings, like numbers refer to like elements.
The following description focuses on an embodiment of the present invention applicable to a dental restoration comprising a bridge framework and in particular to a dental implant, and bridge structure comprising a bridge framework dental a veneering construction, planned in the maxilla (upper jaw bone). However, it will be appreciated that the invention is not limited to this application but may be applied to many other dental restorations, including for example single implants with or without a spacer and attached crowns, and may be used in relation to other implant positions, e.g., in the mandibula (lower jaw bone).
A “dental restoration” comprises dental units such as a dental implant, a bridge framework, a bridge structure, a coping, an abutment, a crown, a veneering, a prepared existing tooth for receiving a coping, etc.
A “dental component” comprises one or several units of a dental restoration, and in addition components used during installation of at least parts of a dental restoration, such as surgical templates.
A “craniooral space” comprises the oral cavity and adjacent soft tissue and bone tissue into which a dental restoration is to be installed.
The implant and dental restoration may then be installed in the patient in a per-se known manner by a dentist.
A number of embodiments of the above outlined method will now be elucidated in more detail with reference to
In an embodiment a dental restoration for an edentulous patient and a dental restorative procedure, as well as corresponding products, are virtually planned, which is now described in detail.
100 Acquire Patient Data
Patient data to be used in the subsequent virtual dental planning method may be acquired in various ways.
The craniooral space of a patient may be scanned by various data generating modalities or apparatuses. For instance, a dental impression of the patient's oral cavity or a part thereof may be produced. Imaging methods, like CT and MR or X-ray, may be used to provide data on deeper anatomical regions of the patient that are not obtainable by surface based data acquiring techniques. Probes may be used to map the soft tissue in the oral cavity of a patient. In addition, data from several input sources may be combined or merged in order to provide patient data serving as input data to the subsequent dental planning method.
A dental impression is often used to create an imprint or negative likeness of for instance the teeth and adjacent portions of the jaw, such as tooth formations, the contour of the gums, etc. Also, for edentulous patients, an impression of only the gums may be taken. The impression is made preparatory to dental repair or restoration of missing dental structures. The dental impression provides data for the topography of an oral cavity of a patient. The dental impression may directly be scanned by means of a three dimensional (3D) scanner system. Patient data may also be acquired from 3D scanning a plaster model produced from such a dental impression. Other methods of acquiring patient data comprise MR scanning the craniooral space of the patient; intra orally 3D surface scanning; using surface probes to determine a thickness of soft tissue in the oral cavity; etc.
As mentioned above, acquired patient data from several different input sources may be matched to provide a combined patient data. Data acquisition and matching methods and systems for planning dental restorations and production of these and related products are detailed described in the co-pending patent application PCT/EP2007/050426 of the same applicant as the present application, filed on Jan. 17, 2007, which hereby is incorporated herein by reference in its entirety.
Sometimes it is not possible to directly acquire an occlusion line of a patient, e.g., for edentulous patients a bite index for acquiring the occlusion line cannot be provided. However, for embodiments of the present method and system this is not necessary. The occlusion line may be reconstructed from anatomically fixed reference points, which are identified in the acquired patient data.
110 Determine Anatomically Fixed Reference Points from Acquired Data
In step 110 of the method, the dental planning is in one embodiment started with the determination of anatomically fixed reference points. Starting from these anatomically fixed reference points, an advantageous position of one or more teeth along the dental arch is determined based on defined mathematical relations of the teeth in relation to the anatomically fixed reference points. For instance, a natural position of the canine (front corner) teeth is determined along the dental arch of a jaw. Each of the canine teeth is delimited by the masticating (chewing) surface along the occlusion line in the oral cavity, respectively. That means the actual position of certain teeth, here the canines, is virtually determined in the dental space in the oral cavity. In this manner, a first boundary surface of each of the teeth is determined, namely the boundary surface of a tooth at a defined spatial position along the occlusion line. A surface that has defined spatial position has a defined position in space. From this first boundary surface, having a spatial position, the spatial positions of boundary surfaces of remaining components of a dental restoration of these teeth are virtually determinable. The dental space between the canines may be automatically filled with template front teeth from a teeth library. The teeth library is for instance provided in digital form in a database comprising at least one three-dimensional virtual template tooth object for each tooth in the maxilla and the mandible.
In a similar way, the position of certain molars (posterior teeth) is determinable. The interspaces between teeth at determined positions are automatically filled with further teeth, e.g., template teeth from the teeth library. This will be elucidated further below with reference to steps 120 to 140 of the method.
Nearest below, the determining of anatomically fixed reference points from acquired data is described.
After marking the first anatomically fixed reference point, further anatomically fixed reference points are marked. This is illustrated in
Further anatomically fixed reference points may be detected automatically or marked manually in a similar way. However, three points are sufficient to define a plane in space and to automatically plan the position and direction of at least one of the teeth in relation to the plane.
From the three anatomically fixed positions marked by the first, second and third marker, an occlusion line 900, as shown in
One way of locating the natural position of teeth is known as for instance disclosed in WO98/20807, of Karl Heinz Staub, which is incorporated herein by reference in its entirety. The method is described in more detail in “Das Staub™-Cranial-System—Reliabilität der Messpunkte zur Rekonstruktion der Zahnstellung im zahnlosen Kiefer”, Panagiotis Lampropoulos, Freiburg, 2003, which is incorporated herein in its entirety. Points in the oral soft tissue are used as anatomically fixed reference points. By using these anatomically fixed reference points, a position of a single tooth or a plurality of teeth in the upper and/or lower jaw is determinable by mathematical calculations. However, the Staub method is based on dental impressions, plaster castings, and manual measurements on the plaster castings. Furthermore, the manual measurements are based on points in soft tissue, or more precisely corresponding points in dental impression based plaster casts thereof. The manual measurements may then be transferred into software that calculates a position of teeth in dental restorations that is very similar to the natural position in the patient before having lost the teeth. Thereby a good occlusion is achieved by dental restorations produced in accordance with these measurements and mathematical calculations. In this manner, highly accurate and predictable dental restorations may be provided. The anatomically fixed reference points are anatomically stable and present in every patient.
Below an example of determining anatomically fixed reference points of the maxillary is given with reference to
The anatomically fixed reference points according to the Staub method are symmetrically arranged in relation to each other. The specific points are referred to as Direction points, Induction points, and the Conclusion line.
Directions points are at the point on the ridge connecting line that exactly determines the change in direction in the curve of the pterygoid hamulus. It has a stable topography and is present on both sides of the maxillary.
Induction points are at the point of intersection of the rear contour of the papilla and the median axis of the maxilla produces the posterior induction point. The anterior induction point is defined as the point of intersection of the anterior contour of the papilla and the median axis of the maxilla. It is the only cranial point which is not anatomically stable.
Like the direction points, the Conclusion line is present on both sides and is anatomical stable. It forms the boundary between mobile and immobile mucosa and determines the change in position in the curve of the mucolabial fold. The conclusion line is at the transition from the concave to the convex form of the mucolabial fold.
Connecting the lines between the two direction points A and B, and the two induction points C and C1, results in two isosceles triangles with the two direction points as the hypotenuse of each. These parameters are used to calculate a penta area, which is defined as the base of the orthocranial occlusion plane. The penta area is used to position the teeth in relation to the maxillary incisal point.
The position of the maxillary incisal point is very important when reconstructing human dentition. Its position is a key importance for phonetics and aesthetics. Together with the exact position of the mandibular incisal point, it enables the vertical dimension of occlusion to be reconstructed to its exact position.
The two isosceles triangles A-B-C and A-B-C1 are determined as described above. The distance from the right canine apex to the left canine apex is determined. Any anatomical conditions of alveolar ridges, palatal fold, etc. do not have an effect on this position. The parameters required for the calculation are topographically stable and enable patient-specific and jaw-specific positioning of the canines.
The following points and distances are determined in order to determine the penta area delimited by the points DFIGE in
In order to provide a reconstruction of the natural teeth position in the edentulous jaw, the two dimensional position of the incisal point I is determined. For this purpose, the distance BC is swiveled with 90 degrees and positioned in the median axis of the maxilla, whereby the distance NI is obtained. The starting point of the distance NI corresponds to the point of intersection of the median axis with the distance AB, see
The distance FG between the canines is calculated as follows, see
This assumes that FG is parallel to AB and that FG<AB. The distance FG has an extension through the centre of the papilla incisiva.
Now the extension of the molar teeth is calculated. The points D and E are the rear points of the distances FD and GE, respectively. These distances provide the position of the buccal occlusion points of the dental restorations along the molar extensions in the penta area, see
As [XD=((BC/2)+2 mm)] and DE=2 XD, results: DE=2×(BC/2)+2 mm), e.g., DE=BC+4 mm. Wherein the constant of 2 mm is empirically determined.
The three dimensional relation of the points D, F, I, G, E result in the position of the penta area.
A mathematical constant value is assigned to the penta area in the maxillary and mandibular, respectively. The constant value determines the incisal point in three dimensional space. The constant is defined as the distance from the conclusion line and amounts to 19 mm in the maxillary and to 17 mm in the mandibular. These values are again empirically determined. In the maxillary, the constant of 19 mm is in correlation to the points N and Z and defines in combination with the mathematically determined penta are the incisal point in space, see
As mentioned above, Staub determines direction points, an induction point, and a conclusion line. Directions points A and B correspond to the second marker 800 and the third marker 810 in
Positioning of teeth in the lower jaw may also be done automatically according to similar principles. In
In order to check if the position of the teeth planned in such an automatic manner is correct, the teeth may be positioned in a virtual articulator. If misalignment of teeth is detected in the virtual articulator, the position and direction of concerned teeth may automatically be adjusted.
For example, in case a single tooth restoration is to be planned, the correct occlusion of a tooth positioned according to the above principle may be checked in relation to the other teeth. Data for the remaining teeth is provided in the acquired patient data, e.g., from a CT scan, a dental impression, or combinations of several data sources.
The method according to Staub is based on anatomical points identifiable in the oral soft tissue that are anatomically fixed reference points. Some embodiments of the invention are based on anatomical points identifiable in the bone tissue that are anatomically fixed reference points. When using these bone tissue based anatomically fixed reference points the method according to Staub is still applicable in embodiments. For instance an offset due to the thickness of soft tissue overlaying the bone tissue may be considered in calculations as described above. The offset may be based on actual measurements of the soft tissue thickness or offset at the location of the anatomically fixed reference points in bone tissue. Alternatively, a fixed offset may be used, e.g., based on empirical patient data.
It is pointed out that the method according to Staub for reconstructing positions of teeth is only one of many possible methods applicable within the scope of embodiments of the present invention. For instance chapter 5.2 (“Rekonstruktion von Zahnpositionen”) of the above cited publication of Panagiotis Lampropoulos, which specifically is incorporated by reference herein, lists various publications according to which calculations of the position of the occlusion line, and positions of teeth of dental prosthesis may be reconstructed from anatomically fixed points.
One of many alternative methods is for instance to calculate the plane of occlusion from the hamular notches or the temporal bones used by the commercially available product Acculiner™. The hamular notches or the temporal bones are stable landmarks in the cranium defined a so-called HIP plane, by means of which the Acculiner™ three dimensionally determines the occlusion plane.
The occlusion plane may also be determined by means of cepaholometric criteria according to Augsburger R H (1953), Occlusal plane relation to facial type, J Prosthet Dent 3:755-770; L'Estrange P R, Vig P S (1975), A comparative study of the occlusal plane in dentulous and edentulous subjects, J Prosthet Dent 33:495-503; Monteith B D (1985), A cephalometric method to determine the angulation of the occlusal plane in edentulous patients; J Prosthet Dent 54:81-87; Monteith B D (1985), Cephalometrically programmed adjustable plane: a new concept in occlusal plane orientation for complete-denture patients, J Prosthet Dent 54:388-394; Sinobad D (1988), The position of the occlusal plane in dentulous subjects with various skeletal jaw-relationships, J Oral Rehabil 15:489-498; Kollmar U (1990); Möglichkeiten der prothetischen Rehabilitation zahnloser Patienten mit Hilfe des Fernröntgenseitenbildes, ZWR 99:451-457.
Other methods of determining the occlusion plane are based a geometric relation to the anatomically fixed Camper plane, also called Ala-Tragus line, see for instance the above cited references Monteith (1985); Karkazis H C, Polyzois G L, Zissis A J (1986), Relationship between ala-tragus line and natural occlusal plane, Implications in denture prosthodontics, Quintessence Int 17:253-255; Karkazis H C, Polyzois G L (1987), A study of the occlusal plane orientation in complete denture construction, J Oral Rehabil 14:399-404; Kazanoglu A, Unger J W (1992), Determining the occlusal plane with the Camper's plane indicator, J Prosthet Dent 67:499-501; Santana-Penin U A, Mora M J (1998), The occlusal plane indicator: a new device for determining the inclination of the occlusal plane. J Prosthet Dent 80:374-375. Camper's plane is defined by three anatomically fixed points in the human skull, namely the spina nasalis anterior and the upper edge of the bony auditory channel (tragion) on the left and right cranial side. Camper's plane is virtually oriented parallel to the occlusion line, but may be corrected with a defined angle. The Camper plane is useful when producing dental prosthesis, for instance according to Maschinski G. Hasenan T, Illig U (2000), Lexikon Zahnmedizin Zahntechnik, München, Urban & Fischer, pp. 123, 560, 581; or Preti G, Koller M M, Bassi F (1992), A new method for positioning the maxillary anterior arch, orienting the occlusal plane, and determining the vertical dimension of occlusion, Quintessence Int 23:411-414.
Using the method of anatomically fixed reference points, it is not necessary to prepare a bite index of the patient for providing a planning with high accuracy.
The anatomically fixed reference points may also be anatomically fixed landmarks.
120 Dental Planning Based on Determined Anatomically Fixed Reference Points
The template teeth are automatically or manually chosen from a library of virtual template teeth, dependent on the current dimensions of maxillary 200, the position of the teeth determined by the above describe mathematical calculations, the distance to occlusion line 900, bone density, each at the respective tooth position, etc. Also, adjacent teeth and the available total dental arch are considered when choosing suitable template teeth from the teeth library.
The virtual template teeth may be positioned and directed according to the principles described with reference to method step 110, e.g., in accordance with the method according to Staub.
For instance, the masticating surface, e.g., boundary surface at the occlusion line for every single tooth, may be calculated. Thereby a spatial position for each tooth is defined with reference to the occlusion line. A line of boundary masticating surfaces along the occlusion line may thus be calculated. Hence, a teeth set-up may be calculated according to the anatomically fixed reference points.
In this way, the position of one virtual template tooth or several virtual template teeth may be determined and an automatic alignment of Standard teeth between the occlusion line and the maxilla bone may be made.
In addition, the position of one or more of the virtual template teeth may be manually adapted, e.g., prior to a continued automatic planning of a positioning of further components for the dental restorative procedure under planning, such as dental implants, bridge frameworks, surgical templates, etc.
In case of planning a ceramic replacement tooth, one boundary surface, that has a spatial position, is at the occlusion line. A replacement tooth may comprise an outer dental veneering that is to be attached to a bridge framework for forming a bridge structure. The dental veneering has an inner boundary surface, that has a spatial position, serving as a connection interface towards a mating boundary surface, that has a spatial position, of a bridge framework (see
130 Calculate Implant's Position and Directions
A suggestion of the position of one or more dental implants, such as the plurality of dental implants 11 a-11 f in the illustrated example, may automatically be determined. This suggestion may be based on the data provided by the planned positions of the virtual teeth, as discussed above.
Embodiments of the automatic determination of implant positions will now be described in more detail.
By means of the planned position of virtual teeth the following method may be applied to determine the position of a dental implant in bone tissue of the patient.
The planned position of a virtual tooth provides a defined, determined position thereof in the craniooral space. The planned position of the virtually planned tooth is based on the occlusion line, e.g., the top end of the virtual tooth is thereby defined. Furthermore, the tooth has a determined position along the dental arch, as well as a defined orientation in the craniooral space.
Jaw bone tissue at locations of extracted or lost teeth, e.g., of edentulous patients, changes over time in comparison with natural jaw bone tissue of patients with natural teeth. The jaw bone tissue shrinks, but may be regenerated by osseoinductive methods. When positioning a dental implant in the area of the virtual root channel of the virtually planned tooth, the dental implant may be positioned too far away from existing jaw bone tissue.
Therefore, a defined space may be defined by the virtually planned tooth within which the dental implant may be implanted in available bone tissue. The defined space may be of cylindrical form and defines the boundaries in vertical direction along which the implant may be positioned. In longitudinal direction the position of the implant may be varied, e.g., depending on remaining anatomical bone tissue, as provided from the patient data. Thus, a space defining a degree of freedom for positioning the dental implant is defined.
The dental implant may be positioned within this space according to a method based on centering the center of gravity of the dental implant in the remaining bone tissue at a defined distance from the boundaries thereof. Thus, sufficient bone tissue is provided for ensuring a secure fixation of the dental implant in the remaining bone tissue. Alternatively, if it is detected that sufficient bone tissue is not available, alternative implant sizes may be chosen.
Centering the center of gravity of the dental implant in the remaining bone tissue may be done as follows. By surface matching, the form of the jaw bone tissue is detected. A top point of the jaw bone tissue is detected, e.g., by a surface finding algorithm. Further points on the surface of the bone tissue are detected laterally at a certain vertical distance from the top point.
The position of the dental implant is then determined in relation to these three defined points. For instance the center of gravity is positioned on a line between the two lateral points and longitudinally below the top point. A defined distance from the surface of the jaw bone tissue is thus ensured and the dental implant is reliably anchored in the jaw bone tissue.
Another way may be to project a plurality of vectors along a defined trace from the center of gravity of the dental implant towards the surface of the bone tissue. This is done for ensuring that the bone surface is found in relation to the position of the implant or to ensure that the implant is positioned correctly or sufficiently far from the boundaries of the bone tissue.
The length of the vectors may be chosen as the distance of the center of gravity of the implant to the top of the implant. The top of the implant is advantageously positioned at the top point or ridge of the jaw bone tissue.
The defined trace along which the plurality of vectors is traced may have different forms from the initial point of the center of gravity, e.g., cylindrical, conical, in one or more planes. This may be done in order to ensure e.g., a defined distance from anatomical structures and/or other dental restorations or implant components.
The vectors may be adaptively defined. For example, a first vector is sent out in 45 degrees direction, and a second vector is sent out in 135 degrees direction. Then it is ensured that these vector meet bone surface and have substantially same length.
The surface of the virtual jaw bone tissue may be defined by a plurality of polygons. The virtual jaw bone tissue may be modeled as a 3D object from these polygons.
In case a vector of the trace meets or cuts through such a polygon, this information may be used for virtually re-orienting the implant in the bone tissue during planning. The implant may thus for instance be centered in the available anatomical jaw bone tissue.
Thus it may be ensured that the implant is positioned with sufficient bone tissue surrounding the latter.
Hence, the automatic positioning of the implant may be object or surface based.
Based on the data of the first boundary surface of the veneering, that has a spatial position at the occlusion line, and the spatial position of the teeth, or boundary surfaces thereof, calculated from the identified anatomically fixed reference points, sufficient data is provided for suggesting a position of the implant. Other parameters that may be taken into consideration are e.g., bone density of jaw bone tissue at the implantation site, extension of nerves and blood vessels, etc.
For instance, the surface of the maxillary bone tissue is determined and the positioning of a coronal end of an implant is positioned at the ridge of the maxillary bone. Furthermore, available bone tissue volume, bone tissue quality, existing implants, etc. may be considered. The implant is positioned in the bone tissue in dependency of the planned positions of the teeth, as discussed above.
The presurgical planning may be made computer based. The planning may be made automatically or in an interactive way with a user. Planning of the dental restoration may in the latter case be made visually on a display of a medical workstation, e.g., of the system described below with reference to
When the implant is positioned, a fixed outer boundary surface of the implant, or a boundary surface of an abutment that is attached to the implant, is determined. Now the intermediate structure between the implant and the veneering will be provided in order to finalize planning of the dental restoration.
140 Automatic Generation of Implant Bridge Framework
At this stage, the spatial position of the dental restoration is defined (step 120) and the spatial position of the implant is defined (step 130). Boundary surfaces of the veneering and the implant, and the spatial positions thereof, are determined and known. The structure in between the veneering and the implant is now virtually planned. This is made in relation to the spatial positions of the implant and the remaining dental restoration, e.g., an interface between the implant and the veneering is calculated and the virtually assembled structure may then be manually fine tuned.
For this purpose, boundary surfaces, having a spatial position, of the veneering and the implant are used.
As mentioned above, the veneering has an outer boundary surface, which has a spatial position, at the occlusion line 900, and an inner boundary surface, that has a spatial position, serving as a connection interface 210 g between the veneering 10 g and an outer boundary surface, that has a spatial position, of a bridge framework 20. At the same time, the bridge framework 20 has a further boundary surface, that has a spatial position, oriented towards the implant 11 d, serving as a connection interface with the latter. The implant 11 d has a top boundary surface, that has a spatial position, serving as the connection interface 215 d with further boundary surface of the bridge framework 20. The boundary surfaces and connection interfaces are illustrated in the enlarged illustration shown in
When fine tuning the position of the implant or the veneering at this stage, an automatic adaptation of the remaining parts of the dental restoration are made. For instance, when manually fine tuning the position of a dental implant, the connection interface 215 d is automatically adapted by recalculating the corresponding boundary surface of the bridge framework 20. Furthermore, the boundary surface on the opposed side of the bridge framework 20, at the connection interface 210 g to the veneering's inner boundary surface, is automatically adapted to the manually induced fine tuning of the position of the implant. Thus, the bridge structure is automatically adapted. Manual fine tuning of other parts of the dental restoration lead to corresponding automatic changes of the boundary surfaces of the remaining units thereof.
150 Approximation of the Final Restoration
Once the user confirms these changes, production of the dental restoration and a drill guide will be based on this new data.
The dental veneering may automatically be produced from the available data.
Furthermore, coloring of the veneering may be made automatically. Various ceramic powders may be virtually planned on the screen. Such techniques are detailed described in the international patent application PCT/SE2005/001406 of the same applicant as the present application, filed on Sep. 23, 2005, which hereby is incorporated herein by reference in its entirety.
Hence, the system may be used for a fully automatic generation of dental restorations. Manual adaptation to specific patient situations, choice selectable from dental restoration component libraries, or other user desires may be performed.
160 Surgical Template Production
When the pre-surgical planning is made, production of dental restorations and/or products related to said pre-surgical planning, such as surgical templates, may be made. For instance, the soft tissue surface and implant position are converted to production data for a drill guide to be used during a surgical implant procedure.
Based on the above described automatic or manually fine tuned virtual presurgical planning, a surgical template may be fabricated, e.g., using rapid prototyping techniques. The surgical template is used in a known way for creating suitable bores for mounting of dental implants, to which the dental restorations will be fixed, at the planned position and with the planned orientation.
Data for products produced by stereolithography, such as a surgical template, may be saved in a suitable format, such as STL. STL (Standard Tessellation Language) files may be imported and exported by a variety of software packages. The STL file is especially suitable for rapid prototyping. This format approximates the surfaces of a solid model with triangles for rapid prototyping. Other data formats than STL suitable for production of dental restorations and related products may alternatively be implemented. Rapid prototyping takes virtual designs from computer aided design (CAD), transforms them into cross sections, still virtual, and then creates each cross section in physical space, one after the next until the model is finished.
The surgical template thus produced provides a good patient fit with high accuracy.
170 Dental Restoration Production
In step 170 of the method, a dental restoration is produced based on the data provided.
A physical patient model may be manufactured from the data provided by the virtual planning, if so desired. A patient model may for instance be used for veneering, in case veneering is desired to be performed manually. Production of a patient model and an articulator are described in Swedish patent applications nos. SE 0602271-9 and SE 0602273-5, which are incorporated herein in their entirety by reference, filed by the same applicant as of the present application. However, this step may be omitted, as the available data provided by the above described automatic virtual planning provides sufficient precision for both presurgical planning and production of surgical templates and dental restorations.
In step 170 of the method, a dental restoration is produced directly from that data provided by the presurgical planning.
Veneering of the dental restoration may be performed in a conventional way. For this purpose a physical patient model may be used. In another embodiment design of the final restoration is made virtually based on the above method steps, whereby manual veneering is no longer necessary.
Finally, the dental restoration is installed in the patient. More precisely, the surgical template produced as described above, is used for providing one or more bores, each receiving a dental implant. Thanks to the high precision with which the surgical template is produced, dental implants are fitted very precise into the jaw bone tissue. Thus a thorough basis is provided for the dental restoration that is then attached to the dental implant in a known manner.
By using the above described method, no casting, sectionizing, and pinning of a plaster model is needed. This provides for faster turnaround times when planning and carrying out dental restorative procedures.
Hence, a very precise positioned dental restoration is provided in a very economical and time saving manner.
Bridge frameworks may be fully automatically planned and produced.
In some treatments even the surgical template is no longer necessary. For instance when producing a coping, such as for a crown, a bridge framework, or a bridge structure, to be attached to a dental preparation, the coping may be produced directly based on the boundary surface and connection interface calculations during the automatic virtual presurgical planning.
In other embodiments a dental restoration for a partly toothless patient and a dental restorative procedure, as well as corresponding products, are virtually planned, which is now described in detail with reference to
A procedure for finding a final connection interface may be controlled by virtually morphing the spatial positions of the two boundary surfaces of elements of a dental restoration. With reference to
This situation may be improved by morphing the second connection interface 261 b towards the outer surface of the crown 262, which is illustrated in
In any case it should be observed that a minimal material strength is preserved when determining the connection interfaces. The above mentioned template teeth in the virtual teeth library may be adapted to tolerate such manipulations, e.g., by having a predefined minimal material thickness at an arbitrary point of a template tooth.
In other embodiments other dental restoration elements may be optimized or defined by morphing techniques, e.g., bridge frameworks. A similar technique to morphing is known as warping.
Diagnosis allowing for orthodontic or surgical corrections of the remaining teeth and automatic adaptation of dental restorations to such corrected teeth positions may be provided. Orthodontic or surgical corrections of the remaining teeth may also be made without a dental restoration, based on the automatically calculated positions of teeth from anatomically fixed reference points.
Existing anatomical structures, teeth, dental implants or other dental restorations of the craniooral space may be identified for consideration in the automatic planning of a dental restoration by surface identification methods. For instance an existing dental implant may be identified in data from a dental impression by the characteristic shape or dimensions thereof. Alternatively, density thresholding, e.g., of the acquired Hounsfield value of CT scans, may assist in identifying objects in patient data of the craniooral space. A segmentation into e.g., soft tissue and bone tissue or teeth may be made for modeling such objects. When anatomically existing objects are identified their outer surfaces may be locked for virtual planning of dental restorations. On the other hand, automatic virtual planning takes these locked surfaces into consideration. For instance an outer shape of a dental bridge framework at the connection interface to a dental implant may automatically be shaped to match the corresponding locked top surface of the dental implant. Alternatively, a top surface of the dental bridge framework may automatically be shaped to match the corresponding inner surface of a veneering when the top surface of the reconstructed tooth also is determined to be at a final spatial position.
In summary, a semi-finished product or a finished product may be provided based on data from the automatic planning method described above. Dynamical modifications may be made during the virtual planning, whereby anatomically existing teeth or dental restorations are considered. A semi-finished product is for instance a dental implant and an associated dental bridge framework, for which a dental technician may manually produce the final veneering of the dental restoration. When providing a finished product, even the veneering may be provided automatically. Furthermore the necessary tools for inserting the virtually planned and produced dental restorations may be produced. For instance, a surgical template for drilling bores, as well as the corresponding drills may be produced.
An embodiment for a system for performing the above described method is schematically illustrated in
The system 1900 provides computer-based planning of a dental restorative procedure of a patient having a craniooral space, and/or of at least one dental component for said dental restorative procedure. The system 1900 has a first unit 1922 for determining a first spatial position of a first boundary surface, in said craniooral space, of a first dental unit of a dental restoration; a second unit 1924 for determining a second spatial position of a second boundary surface, in said craniooral space remote said first boundary surface, of a second dental unit of said dental restoration; and a third unit for determining a third spatial position, of at least a portion of said dental component, relative at least one of said first and second spatial positions.
A medical workstation 1910 comprises the usual computer components like a central processing unit (CPU) 1920, memory, interfaces, etc. Moreover, it is equipped with appropriate software for processing data received from data input sources, such as data obtained from CT scanning or 3D scanning. The software may for instance be stored on a computer readable medium 1930 accessible by the medical workstation 1910. The computer readable medium 1930 may comprise the software in form of a computer program 1940 comprising suitable code segments 190, 191, for planning a dental restorative procedure of a patient and for planning dental components related to the dental restorative procedure. The medical workstation 1910 further comprises a monitor, for instance for the display of rendered visualizations, as well as suitable human interface devices, like a keyboard, mouse, etc., e.g., for manually fine tuning the automatic planning otherwise provided by the software. The medical workstation may be part of a system 1900 for planning a dental restorative procedure of a patient and for planning dental components related thereto. The medical workstation may also provide data for producing at least one of a dental restoration and a product related to the dental restorative procedure.
For planning, patient data, e.g., from a CT scan, is imported into a software for pre-surgical planning of dental restorative procedures, for instance run on the medical workstation 1910. The medical workstation 1910 may have a graphical user interface for computer-based planning of a dental restorative procedure of a patient having a craniooral space, and/or of at least one dental component for said dental restorative procedure. The graphical user interface may comprise components for visualizing the method described above in this specification or recited in the attached claims.
When the pre-surgical planning is made, production of dental restorations and/or products related to said pre-surgical planning, such as surgical templates, may be made. In an embodiment the computer program 1940 is useful for computer-based planning of a dental restorative procedure of a patient having a craniooral space, and/or of at least one dental component for said dental restorative procedure, such as a bridge framework, veneering, surgical template etc. The computer program comprises a first code segment 190 for determining a first spatial position of a first boundary surface, in the craniooral space of the patient, of a first dental unit, e.g., a veneering, bridge framework or dental implant, of a dental restoration. A second code segment 191 is provided for determining a second spatial position of a second boundary surface, which is positioned remote the first boundary surface, of a second dental unit of the dental restoration. The second dental unit is different from said first dental unit and may comprise a veneering, bridge framework or dental implant. The computer program may further comprise a third code segment for determining a third spatial position, of at least a portion of the dental component, relative at least one of the first and second spatial positions. The dental component may for instance be the veneering, bridge framework or dental implant, or a surgical template. For instance, the first spatial position is that of the top surface of a tooth at an occlusion line, the second spatial position is that of a top surface of a dental implant and the third spatial position is that of the connection interface between a bridge framework and the veneering. The computer program may enable carrying out of the method described above in this specification or recited in the attached claims. The computer program may be embodied on a computer readable medium. As mentioned above, the computer program may be executed on a medical workstation or similar computing apparatus suitable for virtual calculations and design purposes.
As used herein, the singular forms “a”, “an,” and “the” are intended to include the plural forms as well, unless expressly stated otherwise. It will be further understood that the terms “includes,” “comprises,” “including,” and/or “comprising,” when used in this specification, specify the presence of stated features, integers, steps, operations, elements, and/or components, but do not preclude the presence or addition of one or more other features, integers, steps, operations, elements, components, and/or groups thereof. It will be understood that when an element is referred to as being “connected” or “coupled” to another element, it can be directly connected or coupled to the other element or intervening elements may be present. Furthermore, “connected” or “coupled” as used herein may include wirelessly connected or coupled. As used herein, the term “and/or” includes any and all combinations of one or more of the associated listed items.
As will be appreciated by one of skill in the art, certain embodiments of the present invention may be embodied as a device, system, method or computer program product. Accordingly, certain embodiments of the present invention may take the form of an entirely hardware embodiment, a software embodiment, or an embodiment combining software and hardware aspects.
Furthermore, certain embodiments of the present invention may take the form of a computer program product on a computer-usable storage medium having computer-usable program code embodied in the medium. Any suitable computer readable medium may be utilized including hard disks, CD-ROMs, optical storage devices, a transmission media such as those supporting the Internet or an intranet, or magnetic storage devices.
Embodiments of the present invention are described herein with reference to flowchart and/or block diagrams. It will be understood that some or all of the illustrated blocks may be implemented by computer program instructions. These computer program instructions may be provided to a processor of a general purpose computer, special purpose computer, or other programmable data processing apparatus to produce a machine, such that the instructions, which execute via the processor of the computer or other programmable data processing apparatus, create means for implementing the functions/acts specified in the flowchart and/or block diagram block or blocks.
These computer program instructions may also be stored in a computer-readable memory that can direct a computer or other programmable data processing apparatus to function in a particular manner, such that the instructions stored in the computer-readable memory produce an article of manufacture including instruction means which implement the function/act specified in the flowchart and/or block diagram block or blocks. The computer program instructions may also be loaded onto a computer or other programmable data processing apparatus to cause a series of operational steps to be performed on the computer or other programmable apparatus to produce a computer implemented process such that the instructions which execute on the computer or other programmable apparatus provide steps for implementing the functions/acts specified in the flowchart and/or block diagram block or blocks.
It is to be understood that the functions/acts noted in the diagrams may occur out of the order noted in the operational illustrations. For example, two blocks shown in succession may in fact be executed substantially concurrently or the blocks may sometimes be executed in the reverse order, depending upon the functionality/acts involved. Although some of the diagrams include arrows on communication paths to show a primary direction of communication, it is to be understood that communication may occur in the opposite direction to the depicted arrows. The present invention has been described above with reference to specific embodiments. However, other embodiments than the above described are equally possible within the scope of the invention. Different method steps than those described above, performing the method by hardware or software, may be provided within the scope of the invention. The different features and steps of the invention may be combined in other combinations than those described. The scope of the invention is only limited by the appended patent claims.
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|18 Mar 2013||AS||Assignment|
Owner name: NOBEL BIOCARE SERVICES AG, SWITZERLAND
Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNORS:NILSSON, URBAN;ANDERSSON, MATTS;REEL/FRAME:030031/0568
Effective date: 20091116
|30 Sep 2016||FPAY||Fee payment|
Year of fee payment: 4